The treatment of irritable bowel syndrome from the modern views on the disease pathogenesis
Abstract
Aim of Review. To conduct analysis of the publications devoted to the new aspects of the pathogenesis of irritable bowel syndrome (IBS) and up-to-date possibilities of the treatment.
Key points. The data received in the recent years provide evidence about the fact that in the development of IBS the genetic factors, the inflammatory changes of the intestinal mucosa and the violation of the balance of the gut microflora play the important role. The treatment of the patients is based on the IBS clinical subtypes and include the antidiarrheal drugs, laxatives and spasmolytics. The good results were obtained during the administration of the combined drug Meteospasmyl (the combination of alverine citrate and simeticone). The topical corticosteroid drugs, mesalazine and probiotics can take their own place in the therapy scheme in the future.
Conclusion. The establishing of the IBS new pathogenic mechanisms gives more possibilities for the treatment.
About the Authors
Ye. A. Poluektova
I.M. Sechenov First Moscow State Medical University
Russian Federation
Russian Federation
S. Yu. Kuchumova
I.M. Sechenov First Moscow State Medical University
Russian Federation
Russian Federation
A. A. Sheptulin
I.M. Sechenov First Moscow State Medical University
Russian Federation
Russian Federation
V. T. Ivashkin
I.M. Sechenov First Moscow State Medical University
Russian Federation
Russian Federation
References
1. Воробьев А.А. Микробиология и иммунология. – М.: Медицина, 1999.
2. Ивашкин В.Т. Основные понятия и положения фундаментальной иммунологии // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2008. – Т. 18, № 4. – С. 4–14.
3. Ивашкин В.Т., Баранская Е.К. Избранные лекции по гастроэнтерологии / Под ред. В.Т. Ивашкина, А.А. Шептулина. – М.: Медпресс, 2002.
4. Ивашкин В.Т., Полуэктова Е.А. О сочетании синдрома функциональной диспепсии и синдрома раздраженного кишечника // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2011. – Т. 21, № 4. – С. 75–82.
5. Кетлинский С.А., Симбирцев А.С. Цитокины. – СПб: Фолиант, 2008.
6. Крыжановский Г.Н. Дизрегуляционная патология: Руководство для врачей и биологов. – М.: Медицина, 2002.
7. Крыжановский Г.Н. Общая патофизиология нервной системы. – М.: Медицина, 1997.
8. Новиков А.В., Яхно Н.Н. Невропатическая боль, патофизиологические механизмы и принципы терапии // РМЖ. – 2001. – № 9 (7–8). – С. 318–327.
9. Павленко С.С. Эпидемиология боли // Неврол. журн. – 1999. – № 4 (1). – С. 41.
10. Шептулин А.А., Кучумова С.Ю. Новое в изучении проблемы синдрома раздраженного кишечника (По материалам докладов 16-й Объединенной Европейской Недели Гастроэнтерологии, Вена, 2008 // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2009. – Т. 19, № 4. – С. 81–85.
11. Andrews CN, et al. Mesalazine (5-aminosalicylic acid) alters faecal bacterial profiles, but not mucosal proteolytic activity in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2011 Aug; 34 (3):374–83.
12. Barthet M, et al. Efficacite de l`association citrate d`alverine-simethiconedans le traitement du syndrome de l`intestine irritable. Gastroenterologie. 1996; 10:2–7.
13. Bengtsson M, Ohlsson B. Psychological well-being and symptoms in women with chronic constipation treated with sodium picosulphate. Gastroenterol Nurs. 2005 Jan– Feb; 28 (1):3–12.
14. Beutheu-Youmba S, Belmonte LE, et al. The expression of the tight junction proteins, claudin-1, occludin and ZO-1 is redused in the colonic mucosa of patients with irritable bowel syndrome. Gut. 2010; 59 (suppl. II):52.
15. Cann PA, Read NW, Holdsworth CD, Barends D. Role of loperamide and placebo in management of irritable bowel syndrome (IBS). Dig Dis Sci. 1984 Mar; 29 (3):239–47.
16. Chang FY, Lu CL, Chen CY, Luo JC. Efficacy of dioctahedralsmectite in treating patients of diarrhea-predominant irritable bowel syndrome. J Gastroenterol Hepatol. 2007 Dec; 22 (12):2266–72.
17. Corinaldesi R, et al. Effect of mesalazine on mucosal immune biomarkers in irritable bowel syndrome: a randomized controlled proof-of-concept study. Aliment Pharmacol Ther. 2009 Aug; 30 (3):245–52.
18. Crentsil V. Will corticosteroids and other anti-inflammatory agents be effective for diarrhea-predominant irritable bowel syndrome? Med Hypotheses. 2005; 65 (1):97–102.
19. Dalmasso G, Nguyen HT, et al. Microbiota modulate host gene expression via microRNAs. PLoS One. 2011 Apr 29; 6 (4).
20. Danne O, et al. Efficacite compare du citrate d`alverine et de la mebeverine chez les adultesattents de troubles fonctionnelsintestinaux. Concour Medical. 1996; 36/37 (suppl).
21. Delvaux M, Wingate D. Trimebutine: mechanism of action, effects on gastrointestinal function and clinical results. J Int Med Res. 1997 Sep–Oct; 25 (5):225–46.
22. Devor M. Pain Mechanism and pain syndromes. 1996. An Updated Review, IASP Press: 103–12.
23. Drossman D.A. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006 Apr; 130:1377–90.
24. Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol. 1996 May; 31(5):463–8.
25. Fire A, Mello CC, et al. Potent and specific genetic interference by double-stranded RNA in Caenorhabditis elegans. Nature. 1998 Feb 19; 391 (6669):806–11.
26. Floch MH, Walker WA, Madsen K, et al. Recommendations for probiotic use-2011 update. J Clin Gastroenterol. 2011 Nov; 45 (suppl):168–71.
27. Foley SJ, et al. Depressed serotonin transporter in platelets of patients with IBS and diarrhea (IBS-D) and coeliac disease: a biomarker a low grade inflammation in duodenal biopsies. Gut. 2008; 57:97.
28. Ford AC, Talley NJ, Schoenfeld PS, et al. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. 2009 Mar; 58 (3):367–78.
29. Ford AC, Talley NJ, Schoenfeld PS, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2009 Mar; 58 (3):367–78.
30. Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and metaanalysis. BMJ. 2008 Nov 13; 337.
31. Ford AC. Management of irritable bowel syndrome. Minerva Gastroenterol Dietol. 2009 Sep; 55 (3):273–87.
32. Hoveyda N, Heneghan C, et al. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterol. 2009; 9:15.
33. Lesbros-Pantoflickova D, Michetti P, et al. Metaanalysis: the treatment of irritable bowel syndrome. Alim Pharm & Ther Dec. 2004; 20, (11–12):1253–69.
34. Lisa Graham. ACG releases recommendations on the management of irritable bowel syndrome. Am Fam Physician. 2009 Jun 15; 79 (12):1108–17.
35. Lobo B, Vicario M, Martinez C, et al. Clinical improvement in IBS after disodium cromoglycate involves mast cell-mediated toll-like receptor signaling downregulation. Gut. 2010; 59 (suppl. II):52.
36. Locke GR 3rd, Zinsmeister AR, Talley NJ, et al. Familial association in adults with functional gastrointestinal disorders. Mayo Clin Proc. 2000; 75 (9):907–12.
37. Loening-Baucke V, Pashankar DS. A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence. Pediatrics. 2006 Aug; 118 (2):528–35.
38. Longstreth GF, et al. Functional bowel disorders. Gastroenterology. 2006 Apr; 130 (5):1480–91.
39. Martinez C, Vicario M, Lobo B, et al. Mucosal mast cell-mediated tight junction impairment correlates to symptom severity in diarrhea-prone irritable bowel syndrome patients. Gut. 2010; 59 (suppl. II):18.
40. Menees SB, Maneerattannaporn M, Kim HM, Chey WD. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2012 Jan; 107 (1):28–35.
41. Migeon-Duballet I, et al. Long-term efficacy and costeffectiveness of polyethylene glycol 3350 plus electrolytes in chronic constipation: a retrospective study in a disabled population. Curr Med Res Opin. 2006 Jun; 22 (6):1227–35.
42. Mohammadian G, Dlugosz A, Lindberg G. Human β-defensins in colon mucosa of patients with irritable bowel syndrome, inflammatory bowel disease and healthy controls. Gut. 2011; 60 (suppl. 3):313.
43. Mueller-Lissner S, Kamm MA, et al. Multicenter, 4-week, double-blind, randomized, placebo-controlledtrial of sodium picosulfate in patients with chronic constipation. Am J Gastroenterol. 2010 Apr; 105 (4):897–903.
44. Rambaud J-C, et al. Gut microflora. Digestive physiology and pathology. John LibbeyEurotext. Paris. 2006.
45. Sackett DL, Strauss SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. Philadelphia, Pa: Churchill-Livingstone, 2000.
46. Schaffstein W, Panijel M, Luttecke K. Comparative safety and efficacy of trimebutine versus mebeverine in the treatment of irritable bowel syndrome. Curr Ther Res 1990; 47:136–45.
47. Schindlbeck NE, Müller-Lissner SA. Dietary fiber. Indigestible dietary plant constituents and colon function. Med Monatsschr Pharm. 1988 Oct; 11 (10):331–6.
48. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011 Sep; 106 (9):1582–91;1581,1592.
49. Sullivan A, Nord CE. Probiotics and gastrointestinal diseases. J Intern Med. 2005 Jan; 257 (1):78–92.
50. Tack J, Müller-Lissner S, et al. Diagnosis and treatment of chronic constipation – a European perspective. Neurogastroenterol Motil. 2011 Aug; 23 (8):697–710.
51. Tudor GJ. A general practice study to compare alverine citrate with mebeverine hydrochloride in the treatment of irritable bowel syndrome. Br J ClinPract. 1986 Jul; 40 (7):276–8.
52. Voorhoeve PM, Agami R. Knockdown stands up. Trends Biotechnol. 2003. Jan; 21 (1):2–4.
53. Wittmann T, et al. Clinical trial: the efficacy of alverine citrate/simeticone combination on abdominal pain/ discomfort in irritable bowel syndrome--a randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2010 Mar; 31 (6):615–24.
54. Zhong YQ, et al. A randomized and case-control clinical study on trimebutine maleate in treating functional dyspepsia coexisting with diarrhea-dominant irritable bowel syndrome. ZhonghuaNeiKeZaZhi. 2007 Nov; 46 (11):899–902.
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For citations:
Poluektova Ye.A., Kuchumova S.Yu., Sheptulin A.A., Ivashkin V.T. The treatment of irritable bowel syndrome from the modern views on the disease pathogenesis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2013;23(1):57-65. (In Russ.)
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